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Retrograde Ejaculation and Fertility: Understanding the Link and Treatment Options

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06 May, 2023
How Retrograde Ejaculation Affects Male Fertility and What You Can Do About It
Retrograde Ejaculation And Fertility

Retrograde ejaculation is a condition in which semen enters the bladder instead of being expelled through the penis during ejaculation – it is a backflow of semen. While it may not be a serious medical condition, it can impact fertility in men. The prevalence of retrograde ejaculation in India is not well-documented, but it is estimated to affect around 0.3% to 2% of men worldwide.


One study conducted in India among diabetic men reported a prevalence of retrograde ejaculation of 11.9%. Another study involving patients with spinal cord injuries found that the prevalence of retrograde ejaculation was 43%.


However, it is important to note that these studies were conducted on specific populations and may not reflect the overall prevalence of retrograde ejaculation in India. Further research is needed to determine the exact prevalence of this condition in the Indian population.

Causes of Retrograde Ejaculation


Retrograde ejaculation can be caused by a variety of factors, including:

  • Medications: Certain medications used to treat conditions such as high blood pressure, prostate enlargement, and depression can cause retrograde ejaculation. These medications include alpha-blockers, antidepressants, and antihistamines.

  • Diabetes: Diabetes can damage nerves that control the bladder, leading to retrograde ejaculation.

  • Surgery: Certain surgeries, such as bladder or prostate surgery, can cause retrograde ejaculation.

  • Spinal cord injuries: Damage to the spinal cord can affect the nerves that control ejaculation, leading to retrograde ejaculation.

  • Ageing: As men age, the muscles that control ejaculation can weaken, leading to retrograde ejaculation.

Symptoms of Retrograde Ejaculation


The primary symptom of retrograde ejaculation is the absence of semen during ejaculation. Instead, the urine may appear cloudy due to the presence of semen in the bladder. Other symptoms may include:

  • Decreased orgasm intensity: Men with retrograde ejaculation may experience a decrease in the intensity of their orgasms.

  • Infertility: Retrograde ejaculation can impact fertility by decreasing the number of viable sperm that reach the egg.

Retrograde Ejaculation Effects On Fertility


Retrograde ejaculation can have a significant impact on fertility in men. When semen is not ejaculated through the penis, it can decrease the number of viable sperm that reach the egg. This can make it difficult for men with retrograde ejaculation to father children. However, it is important to note that retrograde ejaculation does not always result in infertility. Men with retrograde ejaculation can still father children through assisted reproductive technology & techniques such as intrauterine insemination (IUI) or in vitro fertilization (IVF).

Preventing Retrograde Ejaculation


While it may not be possible to prevent retrograde ejaculation in all cases, there are some steps that can be taken to minimize the risk of developing the condition. These include:

  • Avoiding medications that can cause retrograde ejaculation: If you are taking medication that can cause retrograde ejaculation, talk to your doctor about alternative treatment options or adjust the dosage.

    Here are some medications that can cause retrograde ejaculation


    • Alpha-blockers: These medications are used to treat high blood pressure and prostate problems. They work by relaxing the muscles in the bladder neck and prostate, which can cause the ejaculate to flow backwards into the bladder instead of out through the penis.

    • Antidepressants: Certain antidepressants, such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), can cause retrograde ejaculation as a side effect.

    • Antipsychotics: Some antipsychotic medications, including phenothiazines and butyrophenones, can cause retrograde ejaculation.

    • Muscle relaxants: Certain muscle relaxants, such as baclofen and tizanidine, can cause retrograde ejaculation as a side effect.

    • Chemotherapy drugs: Some chemotherapy drugs, such as cyclophosphamide and methotrexate, can cause retrograde ejaculation.

  • Managing underlying health conditions: If you have an underlying health condition such as diabetes or high blood pressure that can lead to retrograde ejaculation, work with your doctor to manage the condition effectively.

  • Avoiding alcohol and drugs: Alcohol and drugs can impair nerve function and lead to retrograde ejaculation, so it is best to avoid or limit their use.

  • Practising pelvic floor exercises: Pelvic floor exercises, also known as Kegels, can help strengthen the muscles that control ejaculation and reduce the risk of retrograde ejaculation.

Success Rates of Fertility Treatments for Retrograde Ejaculation


Intrauterine insemination (IUI) involves placing sperm directly into the female partner’s uterus. This can be done with sperm collected from the urine, and it can be an effective treatment option for retrograde ejaculation. The success rate of IUI can vary depending on the cause and severity of the condition, as well as the age and health of the female partner.


In vitro fertilization (IVF) involves fertilizing the female partner’s eggs with sperm collected from urine or from a testicular biopsy. IVF can be an effective treatment option for retrograde ejaculation, especially in cases where other treatments have been unsuccessful. The success rate of IVF can vary depending on the age and health of the female partner, as well as the quality of the sperm.


Overall, the success rates of fertility treatments for retrograde ejaculation can vary depending on the severity of the condition, the underlying cause, and other factors. It is important for couples to discuss their options with a fertility specialist and to have realistic expectations about their chances of success.

Coping with Retrograde Ejaculation and Fertility

couple who have over come Retrograde Ejaculation

Coping with retrograde ejaculation and fertility can be challenging for couples trying to conceive. However, there are several options available to help couples overcome these challenges.


  • Communicate with your partner – It is essential to communicate openly and honestly with your partner about your condition and how it may affect your fertility. This can help reduce stress and anxiety and increase your chances of success.

  • Seek medical advice – If you are struggling with retrograde ejaculation and fertility, it is important to seek medical advice from a fertility specialist. They can provide you with information about treatment options and help you make informed decisions about your fertility.

  • Consider assisted reproductive techniques – Assisted reproductive techniques such as IVF can help couples with retrograde ejaculation and fertility issues or concerns conceive. These techniques involve collecting sperm and eggs and fertilizing them outside the body before transferring them to the uterus.

  • Donor sperm – In cases where retrograde ejaculation makes it impossible to collect sperm, couples may consider using donor sperm. This can be a difficult decision, but it may be the best option for some couples.

  • Adoption – Adoption is another option for couples who are struggling with retrograde ejaculation and fertility. It is a rewarding way to build a family and provide a loving home for a child in need.

  • Explore alternative treatments – Some couples may choose to explore alternative treatments such as acupuncture or herbal remedies to help improve fertility. While there is limited scientific evidence to support these treatments, some couples find them helpful in reducing stress and improving overall health.

  • Take care of your physical and emotional health – Coping with retrograde ejaculation and fertility can be stressful and emotionally draining. It is essential to take care of your physical and emotional health by eating a healthy diet, getting regular exercise, and seeking support from friends, family, or a therapist.

Complications of Fertility Treatment


Retrograde ejaculation can be a complication of certain fertility treatments, particularly those that involve the injection of sperm into the uterus or fallopian tubes. Intrauterine insemination (IUI) and in vitro fertilization (IVF) are two common fertility treatments that can result in retrograde ejaculation.


During IUI, a sample of sperm is collected from the male partner and injected directly into the woman’s uterus using a catheter. If retrograde ejaculation occurs, the sperm will be ejaculated into the bladder instead of reaching the uterus, reducing the chances of fertilization.


In IVF, the female partner undergoes a process of ovarian stimulation to produce multiple eggs, which are then collected and fertilized with sperm in a laboratory. The resulting embryos are then transferred to the woman’s uterus. Retrograde ejaculation can occur during the process of sperm collection, meaning that the sample collected may not contain enough viable sperm for fertilization.


In cases where retrograde ejaculation cannot be treated, fertility treatments such as IVF with intracytoplasmic sperm injection (ICSI) may be recommended. ICSI involves injecting a single sperm directly into an egg, bypassing the need for the sperm to travel through the female reproductive tract.

Psychological Effects of Fertility Treatment


The psychological effects of fertility treatment for retrograde ejaculation can vary depending on the individual’s emotional state, their relationship with their partner, and their overall experience with infertility.


One common emotional response is anxiety, which can be triggered by the uncertainty of whether the treatment will be successful or not. Men may also experience a sense of loss or grief if they are unable to conceive naturally with their partner.


Fertility treatment can also put a strain on the relationship between partners. The pressure to conceive may cause tension and frustration, leading to feelings of guilt, shame, or inadequacy. Additionally, the cost and time commitment of fertility treatments can create financial and logistical stress.


It’s essential for men and their partners to have access to counselling or support groups during this time to help cope with the emotional impact of fertility treatment. Counselling can help couples communicate their feelings, develop coping strategies, and find ways to maintain intimacy and connection during the treatment process.


Overall, fertility treatment for retrograde ejaculation can have significant psychological effects, but with the right support and resources, couples can navigate the experience and find ways to strengthen their relationship and cope with the challenges they face.


Another psychological effect of fertility treatment for retrograde ejaculation is depression, which can be a result of the frustration and disappointment that comes with unsuccessful attempts to conceive. This can lead to feelings of helplessness and hopelessness, and may even impact daily functioning.


Men may also experience a sense of emasculation, feeling like they are not fulfilling their role as a provider or sexual partner. This can impact their self-esteem and may cause them to withdraw from sexual or social situations.


It’s important for men to recognize that infertility is a medical condition, and seeking treatment does not make them any less of a man. Open communication with their partner and healthcare provider can help address any feelings of inadequacy and provide reassurance and support.


Finally, fertility treatment for retrograde ejaculation can also impact the mental health of women in the relationship. Women may feel a sense of guilt or responsibility for the inability to conceive naturally, and may also experience anxiety and depression throughout the treatment process.


It’s important for couples to support each other emotionally and work together as a team during fertility treatment. This can help mitigate the psychological effects and strengthen the bond between partners. Counselling or therapy can also be beneficial for women to help them cope with the emotional impact of infertility and the treatment process.

Prevention of Retrograde Ejaculation during Fertility Treatment


To prevent retrograde ejaculation during fertility treatment, doctors may use medications such as pseudoephedrine, which can help improve the muscle tone of the bladder and neck, preventing the backward flow of semen. Additionally, doctors may use a technique called penile vibratory stimulation (PVS), which involves applying a vibrating device to the penis to stimulate ejaculation. PVS can be an effective method of collecting sperm for fertility treatments and can be used in cases where retrograde ejaculation cannot be prevented.



  • Singhania P, Kundu AK. Retrograde ejaculation in diabetes mellitus: a prospective study. Indian J Urol. 2000 Jul;17(2):129-33. doi: 10.4103/0970-1591.44251. PMID: 20724048; PMCID: PMC2945237.
  • Srinivasan AK, Heruti RJ, Dodge OG, Gershbein AB. Sexual function in men with spinal cord injuries: a review. J Spinal Cord Med. 1996 Jul;19(3):191-201. doi: 10.1080/10790268.1996.11719379. PMID: 8876361.
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